Michigan Proposal To Merge Medicaid and Medicare Forgot Oversight

Here is the Michigan Proposal for Medicare/Medicaid Eligibility Proposal.

 In 2011, Michigan was competitively selected to receive funding through CMS’ State Demonstrations to Integrate Care for Dual Eligible Individuals. As part of this Demonstration, CMS provided support to the State to design a demonstration proposal that describes how it would structure, implement, and monitor an integrated delivery system and payment model aimed at improving the quality, coordination, and cost-effectiveness of services for dual eligible individuals. 

Michigan is one of 15 states that was chosen for policy development of the integrated care model under the Affordable Care Act, or more readily recognized as "Obamacare". This is the first stage of examining a single payer model. I sit on the State Medicaid Advisory Group and have worked on this. Unfortunately, no one wanted to hear me on integrating a violation mechanism to the attorney general as there is no operational oversight component of the integrated model.

The state Medicaid Fraud Control Unit, which does nothing, will not have jurisdiction with this proposal and neither will the Medicaid Integrity Program.

Medicaid and Medicare fraud is outrageous in Michigan. That is why the H.E.A.T. task force, the DOJ and HHS OIG partnership. has Detroit as one of the first five cities to launch the task force.

I also have concerns that there are no complaint or exclusionary databases recommendations for quality improvement measurements for delivery and efficiency of services.

Michigan seems to be bucking for the Managed Fee for Service model.  Unlike the Capitated model where the state, CMS and a health plan enter into a percentage payment formula, the "managed" model would find ways to save money by reducing costs.  Michigan has already taken legislative initiatives to begin to benefit off its "gaming-the-system" law.

Michigan could "reduce costs" if it would admit it has a severe false claims issue.  Would it not make sense to use the single audit to improve a single payer system?

 Invitation for public comment: We welcome public input on this proposal. To be assured consideration, please submit comments by 5 p.m., May 30, 2012. You may submit comments on this proposal to MI-MedicareMedicaidCoordination@cms.hhs.gov. 

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